Niu Zhongzheng, Ako Ako Adams, Geiger Sarah Dee, Howe Caitlin G, Perng Wei, Singh Rachana, Karagas Margaret R, Elliott Amy J, Cassidy-Bushrow Andrea, Camargo Carlos A, Sanderson Keia, McEvoy Cynthia T, Oken Emily, Dabelea Dana, Hartert Tina V, Carter Brian, Stroustrup Annemarie, Lampland Andrea, O'Connor Thomas G, Gogcu Semsa, Hudak Mark L, Shorey-Kendrick Lyndsey E, Zhao Qi, Ni Yu, VanWormer Jeffrey, Ferrara Assiamira, Hedderson Monique, Zhu Yeyi, Alshawabkeh Akram, Cordero Jose, Koinis-Mitchell Daphne, Carnell Susan, Breton Carrie V, Bastain Theresa M, Farzan Shohreh F
Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles.
Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo.
JAMA Netw Open. 2025 May 1;8(5):e259205. doi: 10.1001/jamanetworkopen.2025.9205.
IMPORTANCE: Higher blood pressure in early life may signal cardiovascular disease over the life course, but determinants of blood pressure in early life are poorly understood. OBJECTIVE: To examine the association of maternal cardiometabolic risk factors during pregnancy with offspring blood pressure from age 2 to 18 years and explore whether the association is modified by offspring sex and race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from the Environmental Influences on Child Health Outcomes program between January 1, 1994, and March 31, 2023. Three common maternal cardiometabolic risk factors during pregnancy were examined: prepregnancy obesity, gestational diabetes, and hypertensive disorders of pregnancy (HDP). EXPOSURE: Maternal cardiometabolic risk factors were retrieved and harmonized from medical records and questionnaires. MAIN OUTCOMES AND MEASURES: Offspring systolic blood pressure (SBP) and diastolic blood pressure (DBP) percentiles adjusted for age, sex, and height were calculated. RESULTS: Among 12 480 mother-offspring pairs (mean [SD] maternal age during pregnancy, 29.9 [6.4] years; 856 of 12 303 identifying as Asian [7.0%]; 1908 as Black [15.5%]; 2305 as Hispanic [18.7%]; 6522 as White [52.3%], and 712 as other [5.8%] race and ethnicity), at least 1 maternal cardiometabolic risk factor was present in 5537 (44.4%), with prepregnancy obesity being the most prevalent (3072 [24.6%]), followed by HDP (1693 [13.6%]) and gestational diabetes (805 [6.5%]). Offspring born to mothers with any cardiometabolic risk factors had higher SBP (4.88 percentile points; 95% CI, 3.97-5.82 percentile points) and higher DBP (1.90 percentile points; 95% CI, 1.15-2.64 percentile points) at their first blood pressure measurement, after adjusting for potential confounders, compared with their counterparts without any risk factors. Hypertensive disorders of pregnancy, alone or with either prepregnancy obesity or gestational diabetes, was significantly associated with higher offspring blood pressure. These associations were generally more significant among female compared with male offspring and among Black compared with other racial and ethnic groups. Among 6015 offspring who had 2 or more blood pressure measures, maternal cardiometabolic risk factors were associated with an increased rate of blood pressure change from age 2 to 18 years (SBP percentile, 0.5 [95% CI, 0.2-0.8] per year; DBP percentile, 0.7 [95% CI 0.5-1.0] per year). CONCLUSIONS AND RELEVANCE: These findings suggest that protecting pregnant individuals from cardiometabolic risk factors may promote healthier blood pressure in the next generation.
重要性：早年血压升高可能预示着一生中心血管疾病的发生，但早年血压的决定因素尚不清楚。 目的：研究孕期母亲心血管代谢危险因素与后代2至18岁血压的关联，并探讨这种关联是否因后代性别、种族和族裔而有所不同。 设计、背景和参与者：这项队列研究分析了1994年1月1日至2023年3月31日期间儿童健康结果环境影响项目的数据。研究了孕期母亲三种常见的心血管代谢危险因素：孕前肥胖、妊娠期糖尿病和妊娠高血压疾病（HDP）。 暴露因素：从医疗记录和问卷中获取并统一母亲的心血管代谢危险因素。 主要结局和测量指标：计算调整了年龄、性别和身高的后代收缩压（SBP）和舒张压（DBP）百分位数。 结果：在12480对母婴中（孕期母亲平均年龄[标准差]为29.9[6.4]岁；在12303名可确定种族和族裔的母亲中，856名是亚洲人[7.0%]；1908名是黑人[15.5%]；2305名是西班牙裔[18.7%]；6522名是白人[52.3%]，712名是其他种族和族裔[5.8%]），5537名（44.4%）母亲至少有一种心血管代谢危险因素，其中孕前肥胖最为常见（3072名[24.6%]），其次是妊娠高血压疾病（1693名[13.6%]）和妊娠期糖尿病（805名[6.5%]）。在调整潜在混杂因素后，与没有任何危险因素的母亲所生后代相比，有任何心血管代谢危险因素的母亲所生后代在首次血压测量时收缩压更高（高4.88个百分位数；95%置信区间，3.97 - 5.82个百分位数），舒张压也更高（高1.90个百分位数；95%置信区间，1.15 - 2.64个百分位数）。妊娠高血压疾病单独存在或与孕前肥胖或妊娠期糖尿病同时存在时，与后代血压升高显著相关。这些关联在女性后代中通常比男性后代更显著，在黑人后代中比其他种族和族裔群体更显著。在6015名有两次或更多次血压测量的后代中，母亲的心血管代谢危险因素与2至18岁血压变化率增加有关（收缩压百分位数每年增加0.5[95%置信区间，0.2 - 0.8]；舒张压百分位数每年增加0.7[95%置信区间，0.5 - 1.0]）。 结论和意义：这些发现表明，保护孕妇免受心血管代谢危险因素的影响可能有助于下一代拥有更健康的血压。
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